scholarly journals CT pulmonary angiography in COVID-19 pneumonia: relationship between pulmonary embolism and disease severity

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Aya Yassin ◽  
Maryam Ali Abdelkader ◽  
Rehab M. Mohammed ◽  
Ahmed M. Osman
Keyword(s):  
Pulmonary Embolism ◽  
Disease Severity ◽  
Laboratory Data ◽  
Pulmonary Angiography ◽  
Significant Relation ◽  
Ct Pulmonary Angiography ◽  
Laboratory Results ◽  
Severity Of The Disease ◽  
The Relationship ◽  
D Dimer

Abstract Background Pulmonary embolism (PE) is one of the known sequels of COVID-19 infection. We aimed to assess the incidence of PE in patients with COVID-19 infection and to evaluate the relationship between the CT severity of the disease and the laboratory indicators. This was a retrospective study conducted on 96 patients with COVID-19 infection proved by positive PCR who underwent CT pulmonary angiography (CTPA) with a calculation of the CT severity of COVID-19 infection. Available patients’ complaint and laboratory data at the time of CTPA were correlated with PE presence and disease severity. Results Forty patients (41.7%) showed positive PE with the median time for the incidence of PE which was 12 days after onset of the disease. No significant correlation was found between the incidence of PE and the patients’ age, sex, laboratory results, and the CT severity of COVID-19. A statistically significant relation was found between the incidence of PE and the patients’ desaturation, hemoptysis, and chest pain. A highly significant correlation was found between the incidence of PE and the rising in the D-dimer level as well as the progressive CT findings when compared to the previous one. Conclusion CT progression and the rising in D-dimer level are considered the most important parameters suggesting underlying PE in patients with positive COVID-19 infection which is commonly seen during the second week of infection and alert the use of CT pulmonary angiography to exclude or confirm PE. This is may help in improving the management of COVID-19 infection.

scholarly journals Investigation of Suspected Pulmonary Embolism at Hutt Valley Hospital with CT Pulmonary Angiography: Current Practice and Opportunities for Improvement

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Nick Kennedy ◽  
Sisira Jayathissa ◽  
Paul Healy
Keyword(s):  
Pulmonary Embolism ◽  
Current Practice ◽  
Pulmonary Angiography ◽  
Pretest Probability ◽  
British Thoracic Society ◽  
Suspected Pulmonary Embolism ◽  
Ct Pulmonary Angiography ◽  
Wells Score ◽  
Positive Rate ◽  
D Dimer

Aims. To study the use of CT pulmonary angiography (CTPA) at Hutt Hospital and investigate the use of pretest probability scoring in the assessment of patients with suspected pulmonary embolism (PE).Methods. We studied patients with suspected PE that underwent CTPA between January and May 2012 and collected data on demographics, use of pretest probability scoring, and use of D Dimer and compared our practice with the British Thoracic Society (BTS) guideline.Results. 105 patients underwent CTPA and 15% of patients had PE. 13% of patients had a Wells score prior to their scan. Wells score calculated by researchers revealed 54%, 36%, and 8% patients had low, medium, and high risk pretest probabilities and 8%, 20%, and 50% of these patients had positive scans. D Dimer was performed in 58% of patients and no patients with a negative D Dimer had a PE.Conclusion. The CTPA positive rate was similar to other contemporary studies but lower than previous New Zealand studies and some international guidelines. Risk stratification of suspected PE using Wells score and D Dimer was underutilised. A number of scans could have been safely avoided by using accepted guidelines reducing resources use and improving patient safety.

D-Dimer Assay to Exclude Pulmonary Embolism in High-Risk Oncologic Population: Correlation with CT Pulmonary Angiography in an Urgent Care Setting

Radiology ◽  
2008 ◽  
Vol 247 (3) ◽  
pp. 854-861 ◽  
Author(s):  
Valencia King ◽  
Anjali A. Vaze ◽  
Chaya S. Moskowitz ◽  
Larry J. Smith ◽  
Michelle S. Ginsberg
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Care Setting ◽  
Pulmonary Angiography ◽  
Urgent Care ◽  
Ct Pulmonary Angiography ◽  
Population Correlation ◽  
Urgent Care Setting ◽  
D Dimer

scholarly journals CT Pulmonary Angiography in Young Women

2017 ◽  
Vol 24 (3) ◽  
pp. 423-428 ◽  
Author(s):  
Paul D. Stein ◽  
Fadi Matta ◽  
Kate E. Hughes ◽  
Mary J. Hughes
Keyword(s):  
Pulmonary Embolism ◽  
Pregnant Women ◽  
Chest Radiograph ◽  
Young Women ◽  
Acute Pulmonary Embolism ◽  
Pulmonary Angiography ◽  
Ct Pulmonary Angiography ◽  
Computed Tomographic ◽  
Lung Scan ◽  
D Dimer

The purpose was to determine whether young women in the emergency department who received computed tomographic (CT) pulmonary angiograms were evaluated to receive lower dose imaging or no imaging, recognizing that the risks of radiation are particularly high in young women. This was a retrospective cohort investigation of women aged 18 to 29 years seen for suspected acute pulmonary embolism in emergency departments of 5 regional hospitals from May 1, 2015 to April 30, 2016. Computed tomographic (CT) pulmonary angiograms were obtained in 379 young women. Pulmonary embolism was diagnosed by CT angiography in 2.1%. A Wells probability score could be calculated in 11.9%. D-dimer was obtained in 46.2% and a chest radiograph was obtained in 41.7%. Among patients with a normal chest radiograph, 3.9% had a lung scan. Venous ultrasound of the lower extremities was obtained in 1.8%. Each had an elevated D-dimer. Among the young women who received CT angiograms, 53 were pregnant. In 17.0% of pregnant women, a Wells clinical probability score could be calculated from the medical record. D-dimer in pregnant women was obtained in 30.2%, chest radiograph in 22.6%, lung scan in 11.3%, and venous ultrasound of the lower extremities in none. In conclusion, young women and pregnant women often received CT pulmonary angiograms for suspected acute pulmonary embolism without an objective clinical assessment, measurement of D-dimer, lung scintiscan, or venous ultrasound, which may have eliminated the need for CT pulmonary angiography in many instances.

scholarly journals D-dimer negative pulmonary embolism

2018 ◽  
Vol 5 (2) ◽  
pp. 429
Author(s):  
Dhananjaya M. ◽  
Kirankumar Meti ◽  
Rajendrakumar Parakh
Keyword(s):  
Pulmonary Embolism ◽  
Tertiary Care ◽  
Safety Margin ◽  
Final Diagnosis ◽  
Pulmonary Angiography ◽  
Clinical Suspicion ◽  
Care Hospital ◽  
Ct Pulmonary Angiography ◽  
The Mean ◽  
D Dimer

Background: Pulmonary embolism (PE), is one of the major cardiovascular causes of death. Pulmonary embolus (PE) can be fatal but is often treatable if recognized early. Unfortunately, the clinical presentation of PE is often variable and misleading mimicking other illnesses and hence known as "the Great Masquerader," making diagnosis difficult. The D-dimer assay has recently come into favour as a method to exclude PE; however, this test has an acceptable safety margin only in low-risk populations.Methods: Present study included 35 patients with clinical suspicion of pulmonary embolism admitted at the tertiary care hospital of North Karnataka during the period from October 2016 to September 2017. Patients were classified according to final diagnosis by CT Pulmonary Angiography into 28 cases positive for PE (80%) and 7 cases negative for PE (20%).Results: Present study included 35 cases suspected to have PE (26 males and 9 females). Their age ranged from 33 to 72 years, with a mean age 48.9 ±14.2 years. 28 cases positive for PE (80%) and 7 cases negative for PE (20%). The mean age of positive and negative PE cases was 48.1±11.2 and 46.4±8.8 respectively. Results of D-dimer test were positive in 10 cases (35.7%) and were negative in 18 cases (61.3 %) of PE.Conclusions: This report highlights the risk of misdiagnosing PE if relying solely on ELISA D-dimer for exclusion. This report documents the presentation of PE despite having unremarkable ELISA D-dimer measurements and highlights the importance of clinical suspicion.

scholarly journals Pulmonary thromboembolism in COVID-19 Patients on CT Pulmonary Angiography - A Single-Centre Retrospective Cohort Study in the United Arab Emirates

2021 ◽  
Author(s):  
Ghufran Aref Saeed ◽  
Waqar Haider Gaba ◽  
Abd Al Kareem Mohd Adi ◽  
Reima Obaid Al Marshoodi ◽  
Safaa Saeed Al Mazrouei ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
United Arab Emirates ◽  
Pulmonary Thromboembolism ◽  
Pulmonary Angiography ◽  
Rt Pcr ◽  
Ct Pulmonary Angiography ◽  
Exclusion Criteria ◽  
The Mean ◽  
Positive Groups ◽  
D Dimer

Purpose. Our aim is to identify the prevalence and distribution of pulmonary thromboembolism in COVID-19 infected patients in our hospital. Materials and Methods. Data of all patients with COVID-19 infection either on RT-PCR testing or non-contrast high resolution CT(HRCT) who had CT pulmonary angiography (CTPA) from April to June 2020 were included. 133 patients were initially included in the study, 7 were excluded according to exclusion criteria, leaving a total number of 126 patients. Results. Twenty (15.8%) patients had evidence of pulmonary embolism (PE) on CTPA with mean age of 50 years (range 31-85) of which 95% were males. The mean D-dimer was 5.61mcg/mL among the PE-negative and 14.49 mcg/mL in the PE-positive groups respectively. Among the patients with evidence of pulmonary embolism on CTP, almost half required admission to intensive care unit in comparison to only one-fifth with negative CTPA. One-fourth died among the PE positive group with only 5% died among the PE negative group. There was a 33% reduction in the development of PE in the COVID-19 patients who had received low molecular weight heparin (LMWH) prior to their CTPA study versus those who had not. Conclusion. D-dimer correlates well with the incidence of pulmonary embolism among COVID-19 patients. Our data suggest that majority of our patients, developed pulmonary embolisms within 5 days into their hospital stay, accounting to almost two thirds of all positive cases diagnosed by CTPA. Those with PE among COVID-19 patients have high chances of ICU admission and mortality. Use of thromboprophylaxis early on might reduce the incidence of PE.

scholarly journals Utilization of CT Pulmonary Angiography in Suspected Pulmonary Embolism in a Major Urban Emergency Department

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Adil Shujaat ◽  
Janet M. Shapiro ◽  
Edward Eden
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Clinical Information ◽  
Pulmonary Angiography ◽  
Suspected Pulmonary Embolism ◽  
Ct Pulmonary Angiography ◽  
Clinical Probability ◽  
Emergency Department Patients ◽  
One Year ◽  
D Dimer

Objectives. We conducted a study to answer 3 questions: (1) is CT pulmonary angiography (CTPA) overutilized in suspected pulmonary embolism (PE)? (2) What alternative diagnoses are provided by CTPA? (3) Can CTPA be used to evaluate right ventricular dilatation (RVD)?Methods. We retrospectively reviewed the clinical information of 231 consecutive emergency department patients who underwent CTPA for suspected PE over a one-year period.Results. The mean age of our patients was 53 years, and 58.4% were women. The prevalence of PE was 20.7%. Among the 136 patients with low clinical probability of PE, a d-dimer test was done in 54.4%, and it was normal in 24.3%; none of these patients had PE. The most common alternative findings on CTPA were emphysema (7.6%), pneumonia (7%), atelectasis (5.5%), bronchiectasis (3.8%), and congestive heart failure (3.3%). The sensitivity and negative predictive value of CTPA for (RVD) was 92% and 80%, respectively.Conclusions. PE could have been excluded without CTPA in ~1 out of 4 patients with low clinical probability of PE, if a formal assessment of probability and d-dimer test had been done. In patients without PE, CTPA did not provide an alternative diagnosis in 65%. In patients with PE, CTPA showed the potential to evaluate RVD.

A Systematic Review of Double Low-dose CT Pulmonary Angiography in Pulmonary Embolism

2019 ◽  
Vol 15 (5) ◽  
pp. 453-460 ◽  
Author(s):  
Sultan Aldosari ◽  
Zhonghua Sun
Keyword(s):  
Systematic Review ◽  
Pulmonary Embolism ◽  
Image Quality ◽  
Radiation Dose ◽  
Contrast Medium ◽  
Low Dose ◽  
Pulmonary Angiography ◽  
Ct Pulmonary Angiography ◽  
Low Contrast ◽  
Low Contrast Medium

Background: The aim of this study is to perform a systematic review of the feasibility and clinical application of double low-dose CT pulmonary angiography (CTPA) in the diagnosis of patients with suspected pulmonary embolism. Discussion: A total of 13 studies were found to meet selection criteria reporting both low radiation dose (70 or 80 kVp versus 100 or 120 kVp) and low contrast medium dose CTPA protocols. Lowdose CTPA resulted in radiation dose reduction from 29.6% to 87.5% in 12 studies (range: 0.4 to 23.5 mSv), while in one study, radiation dose was increased in the dual-energy CT group when compared to the standard 120 kVp group. CTPA with use of low contrast medium volume (range: 20 to 75 ml) was compared to standard CTPA (range: 50 to 101 ml) in 12 studies with reduction between 25 and 67%, while in the remaining study, low iodine concentration was used with 23% dose reduction achieved. Quantitative assessment of image quality (in terms of signal-to-noise ratio and contrast-to-noise ratio) showed that low-dose CTPA was associated with higher, lower and no change in image quality in 3, 3 and 6 studies, respectively when compared to the standard CTPA protocol. The subjective assessment indicated similar image quality in 11 studies between low-dose and standard CTPA groups, and improved image quality in 1 study with low-dose CTPA. Conclusion: This review shows that double low-dose CTPA is feasible in the diagnosis of pulmonary embolism with significant reductions in both radiation and contrast medium doses, without compromising diagnostic image quality.

scholarly journals COVID-19-induced vascular angiopathy: CTPA signs in critically ill patients other than acute pulmonary embolism and high-lung opacity scores

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Mohamed Hossameldin khalifa ◽  
Ahmed Samir ◽  
Ayman Ibrahim Baess ◽  
Sara Samy Hendawi
Keyword(s):  
Artificial Intelligence ◽  
Pulmonary Embolism ◽  
Lung Volume ◽  
Acute Pulmonary Embolism ◽  
Pulmonary Angiography ◽  
Vascular Tree ◽  
Ct Pulmonary Angiography ◽  
Artificial Intelligence System ◽  
Intelligence System ◽  
Severity Scores

Abstract Background Vascular angiopathy is suggested to be the major cause of silent hypoxia among COVID-19 patients without severe parenchymal involvement. However, pulmonologists and clinicians in intensive care units become confused when they encounter acute respiratory deterioration with neither severe parenchymal lung involvement nor acute pulmonary embolism. Other radiological vascular signs might solve this confusion. This study investigated other indirect vascular angiopathy signs on CT pulmonary angiography (CTPA) and involved a novel statistical analysis that was performed to determine the significance of associations between these signs and the CT opacity score of the pathological lung volume, which is calculated by an artificial intelligence system. Results The study was conducted retrospectively, during September and October 2020, on 73 patients with critical COVID-19 who were admitted to the ICU with progressive dyspnea and low O2 saturation on room air (PaO2 < 93%). They included 53 males and 20 females (73%:27%), and their age ranged from 18 to 88 years (mean ± SD=53.3 ± 13.5). CT-pulmonary angiography was performed for all patients, and an artificial intelligence system was utilized to quantitatively assess the diseased lung volume. The radiological data were analyzed by three expert consultant radiologists to reach consensus. A low CT opacity score (≤10) was found in 18 patients (24.7%), while a high CT opacity score (>10) was found in 55 patients (75.3%). Pulmonary embolism was found in 24 patients (32.9%); three of them had low CT opacity scores. Four other indirect vasculopathy CTPA signs were identified: (1) pulmonary vascular enlargement (57 patients—78.1%), (2) pulmonary hypertension (14 patients—19.2%), (3) vascular tree-in-bud pattern (10 patients—13.7%), and (4) pulmonary infarction (three patients—4.1%). There were no significant associations between these signs and the CT opacity score (0.3205–0.7551, all >0.05). Furthermore, both pulmonary vascular enlargement and the vascular tree-in-bud sign were found in patients without pulmonary embolism and low CT-severity scores (13/15–86.7% and 2/15–13.3%, respectively). Conclusion Pulmonary vascular enlargement or, less commonly, vascular tree-in-bud pattern are both indirect vascular angiopathy signs on CTPA that can explain the respiratory deterioration which complicates COVID-19 in the absence of severe parenchymal involvement or acute pulmonary embolism.

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